HomeMy WebLinkAboutBuilding Permit #224-15 - 675 FOSTER STREET 9/2/2014 BUILDING PERMIT of N°Dr 6�tio
TOWN OF NORTH ANDOVER 02
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received eL "0 Arab
�SSACHUs�t
Date Issued:
'IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNERPV
Print _ 100 Year Structure yes no
MAP _ . PARCEL. _ ZONING DISTRICT: Historic District yes �o
Machine Shop Village yes (9
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
El Septic ❑Well ❑ Floodplain 0 Wetlands. ❑ Watershed District
0 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
i x
Identification- Please Tr Print Clearly
OWNER: Name: y a o
L — Phone: -`3 O
Address: AD- 0 rg 5
Contractor Name: Phone: -
Address:
Supervisor's Construction License: Exp. Date:
Home Improvement License: -- -_ vExp _`Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ / � FEE: $ D
Check No.: �� Receipt No.��
NOTE: Persons contractingwith unregistered contractors do not have access to the uaran and
g g t1'f
Signature of Agent/Owne Signature of contractor -
Location �Y 1
No. Date 2
J
i
. - TOWN OF NORTH ANDOVER {
• ter, Certificate of Occupancy
:
a, Building/Frame Permit Fee , '
Foundation Permit Fee $ �
r�,
A `
Other Permit Fee $
TOTAL $
Check 4AV
27971
Building Inspector
Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
'FIRE DEPARTMENT Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Dimension
square feet of floor area
Number of Stories: Total sq , based on Exterior dimensions.
Total land area, sq. ft.:
l
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No !
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
I
i
❑ Notified for pickup Call Email
Date Time Contact Name
Doc.Building Permit Revised 2014
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
o Building Permit Application
o Workers Comp Affidavit
o Photo Copy Of.H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks.
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
Li Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
a Mass check Energy Compliance Report (If Applicable)
Li Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
o Building Permit Application
❑ Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
❑ Mass check Energy Compliance Report
D Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
Doe:Building Permit Revised 2014
• , Office o,f fives igado ys
6#0 Washixeon Street
Rostow,1YA 112111
vimmass go-PlAz
worckex,5'CrIompexwatio)xInsumue Aradavif:Bader oicoYa.tractor§;XleP-t-ricialasOluJkbUP
n�lxeax�t)OrC7Zm *.Ox1 Please P xn ibZy
Namo(. usia ogorganisationlJ'n&1dud).
City/slel. p: Kk), N00\1 , tY1__ _ Pbon� f o
.A.re you an.employer?Clieektho,appropriate box: Type of project(required}
I.[] lama emlaloyer with �. am a general contractor and €, New constractzon
employees(Ill andlaxpaxt titue).T have laixedthesub-contractors
- 7•
listed on the attached sheet°� �(l�.emodeling
2.El S am.a solepruxietor orpatfnex
BMP and'havena.employees . These suh-o nfractowhave 8. El Demolifion
woxk3aag forme in any capacity. workers'comp.insurance. g, El D-p fffflng addition
[No workers'camp.Jhsuxauce 5. ❑We are a corporation and its 101]Eleetricalxepairs or additions
'
officers have exrcised.their
ed.
3. X am a la omeowner doing all work right of exemptiaaa per MGL 11111'1bgxepairs or acicizEzons
anyseL�1rloworkers'comp. c.152,§1(4),aa3.dwehaveio 12.PRaof3:epairs
ir�surazzcorequixed.�? employees.[Noworkexs' 13.[]other
comp.insurance required.]
Any a-PpliGantthaschecksbox#1 'compensafion.policyinfonmation.
7 Homeowners wha submifthis aftdavitindioatingtheyaxe dping allwor1Vandtbenbire outside canfraotors must submit a nevi affidavit iudica�ig such.
tContracforsthat chs
edctbh bo must attached m addidonat sheetshowkgfbename of the sub.-codracfors anftekwonkers'comp.poRcyinformation.
I arnax2 exnproyeNtliaizsp avic irag orX�exs?cornpeta�atio insr�xar�cefor��y er Ioyees�, i3e�ow ist�ie la.Zicy ar2tl'jo ,site
in,fo�.matior�. .
Insurance companyN•ame:.
Policy ore ins. zc.#: ExpixatoazDafe:
Y'ob;Site.A.ddress: City/State/Zip: '
.A_itaela a copy az tiia workers'comp ensatioxaToltey cleclaratiox[page(showing tlie paSicy number and expiratiau date).
Failure to secuxo coverage as xegdred tuzder Section.25A ofMGL c.152 can,lead to the imposition of exkAalpenalties of a
faze up to$1,500.00and/or flne�year ianprisonmez�t,as welf as civilpenalties in the form of STOP-WORK ORDM and a fm.e
ofup to$250.0 0 a.day'against the vivZafor. B e advised that a copy'of this atatena ent may he fozwaxded to the Office of
Investigations of:the DS&for b1swan.ce coverage vexiffcatian.
Xdo Xiereby eero urictvge-yaw wulFenaZties ofperjury Mid Ate informatiov providedabove true andeorreet`,
Si
Data: 9 c�-
I'laane#:
Ojffelal use oBly. ,Do not write in this area,to be eornpreted by city or lOwn olczaf
City or Town: FerznztlLicense#
fssuuing.A-ath.ority(circle ORO):
1.$aarcl of ealth 2,$uildzxcgJ[�epartmend 3.C 4ffowa clerk 4.Hlectxicalfuspeetor S BurubingInspector
f.Other ~ ~ ~
-4
information and Instructions .,
Massachtlsetfs GOneral Laws Chapter 152 requires all employers to provide workers'compensation for them employees.
Puxsuarit to this statute,an e�r�,p7oyee is defined as"...every person iri the service of another itndex any coxiiract ohixe,•
express orimplied,oral oxw.r1tten2,
M eftTZoye is defined as"ar!individual, arZztersbi ,assocxatzon,corporation.ox othexlegal entity,ox any two ox.moxe•
Of tho f6xego3ng engaged in a joint eutexpxise,and includingthe legal representatives ofa•deceased e2nplayex,.or the,
receiver or-Irdstee of an individual partnership,association or other legal entity,employing employees. Howevax the
owner of a dwelling house having notmoro than tbree apartments and who resides therein,or the o ccupard ofthe
dwelling house of anofhex who employs persons to do maintenance,consfx+zcfion oxxepaix work on such dwelliug house
ar on the grounds or building appurtenantthexefo
shall not because ofsuch employmeatba deemed to be an employer:"
MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to op erate a business or to constiruct buildings in the commonwealth for anty
applicant who has not pr0duced-ac ceptable evidence of compliance with.the Insurance coverage required;'
Additionally;MCL chap�tex 152,§25C(7)states I` aitherthe commonwealthnor any of its political subdivisions shall
enter into any contractfor the performaac0 ofpubliaworkuntzl accepfableevidence of compliance with the insurance
requirements ozIbis chapterhave b eenpresented to the contracting authority:"
Applicant.-
-Please SII out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,i;
necessary,supplysub-contractor{s}names},address(es}andphonenumbex(s)alongwntlieixcett Cafes)o
insurance. LimitedLiabilitycomyanies(LLC}oxL7mifedLiabilitypat-tnersbzps(LI,p}�vifb.na employees ot7iexthattthe
members or partners,axenotregairedto cany workers,compenmtioninsurance. IfanL►_coxLLF doeshave
employees,apolicyis required. De advhodthatthis affidavit maybe submitted to thoDepartment o£Industrial.
Accidents fox confirmation of insurance coverage. ATso be luxe to sign and date-the adavlt.
11e affidavit should
be refumedto the city or town that the application iox tiiepero�it ox license is being xeguested,nod the De�atimenf of
lndusfr alAcoidenfs. Shouldyouhave any questionsregaxding the law or ii you arexcq edto oba oxkexs'
compensationpolicy,ylease call the Deparbnent atth�numbex listed below: Self insured companies should enter their
• self insurance license number on the appropriate Itne. .
City or Town Officials
Pleasebeswothattheaii[davitiscomploteaud.Vxintedlegibly. The Department has provided aspaceatthebottom
of the aif"idavitfoxyouta alt out intlie eve
ntthe Office of Investigationshas to contactyouxegaxdingtb.e applicant.
'lease be sizxe to z"i11 in the pem t/license number which will be used as a xezexence nt7mber, IR addition,an applicant
that lnust submitnmltiple permit/liceme applications in any givenyear,need only submit one affidavit indicating current
PAT information(Xnecessmy)and under"M,Site Address"the applicant should write"all locations in (city or
towtl)."Acopyo tlieafftdaviGthathasbeenoftciallystampedormarked bythecityoxtownxaaybep�ovidedtothe
applicant as proof:thatavandaffidavit•isonfilef`orItozepexmitsorlieenses. Anew azfxdavitmustbeflledouteach
year.�Itere ahoxae owner ox citizenis obtaining alicense oxpexmitnotrelafed to anybusiness or commercial venture
(10.a dog Er orpermitto burn leaves etc,}saidpexson is I�OTxequiredto plete this affidavit.
Tho Oflzce 6f l'nvesfigaffons would like to thank you in advance for youx coop exaffon and should you have any gizestxons, "
please do not heaitafe to give us a call.
Uaa.Depaxtmeaes address,telephone aizd faxnumbex�
14axtMOIR Qfbdu W AcoMe t.
Moe Q:Jff1wQWgAVo.) %
600 WaWnnon�"xe
Tear 0 617-7-21Z-4900 a:d 406 QT I-a77-MASSAFE _
$evzsecl5 z6-()5 FM#617-727-7749
' ��•� t�av�c��
r 1 NORTH
E , . id : ve.
0
No. 10'1-01- 115
Ca h ver, Mass,
cocmc.42WICK
A0A?ATED
S V
BOARD OF HEALTH
Food/Kitchen
PERMI-T T LD AU)
Septic System
THIS CERTIFIES THAT ...... ..C.141P. • BUILDING INSPECTOR
. � 015
Foundation ,
has permission to erect .......................... buildings on .... ... ........... ....*........
• Rough
tobe occupied as ......... . ..... .At.r........ ..�......�..................................................... Chimney
provided that the person accept g this permit all in every respect conform to the terms of the application Final
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 0TH _ ,, ELECTRICAL INSPECTOR
UNLESS CONSTRUCTI ST I S Rough
Service
...............f" ............. ............................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
.' eRr •.
TO"OF-NORTH ANDOVER
OFFICE OF '
600 Dsgood S` 00tBuitdiug20,-Surte 2-36
XoAhAu var Massachusetts Q1845
S�ACHUS�
Gerald A.Brown - Telephone(978)688 945
InspeetorofBtiildings Fax (978)688-9542
ROMEOWNER•LIOENSE EXEMPTION
Bb�r �- I'E CT.2. YLZCATX0-N
Pleaseprmt .
DATE:
J-OB LOCATION: _
Number S lea Address Map/I of
z�°�°�R L �oU
Name• Horne Phone '
' WorkPhone
PPM-SENT MA MING ADDRESS
CIt1 Tn vn �f fw• .
9,p Cods
The euzrent exemption for"homeowners"was extended to-;
ICD allow such homPo;,- t�ChideowIlex OC�Lipied divelliugs to t4vo units•orle552nd
uers to engage an?rcivaaual.forire wno does aotpossess alicense,provided thatthe owner
acts as supezvzsor). ,8zafe3uilding (Code Section
DEF IMON 0F1q0ME0VWR-
I?erson(s)who awns apazcel ofland on which he/she resides or intends to reside,on which there xs,or is intended to 1
be,a one or two f'arnily simctares. A p erson who constriiets more thatone home in a iwi h Ther e;k d shall not�e
cozzsidered a bomeowzez
The undersigned"homeowner"assutnesrespDuszi i1i�€yforcompliances wifh the State Building Code and other
Applicable codes,by-laws,rules and-legalations.
The undersigned"hozneownez"cert'Res that he/she understands the Town of Norih AadoverBuzlding Detiartment
:„i--n;rr,uzn inspecfion procedures and requirements an
requirements, dthat he/she will complyyxthtsazd procedures and
HOMEOWMERS SIGNATMEd
.A.1 PROVAL OF BUILDING OFFICIAL
ReY19ed 7.2009 .
FoimRomeowners Zsxemption
'13 DAM OFAPPBA7,5 688-9541r
CO3\rSHRYATION 688-9530 HEALTH 689-9540 PLANNING -
6$8-9535